Notwithstanding the advances in tendon surgery during the past half century, a significant number of patients with flexor tendon injuries do not regain satisfactory functions. Such injuries result in severe functional loss from adhesion of repaired tendons, stiffness and flexion contracture of the fingers.
The principal theory for base-of-tendon healing has been the extrinsic mechanism by synovial sheath, pari-sheath, and migration of fibroblasts, although a number of researchers have reported strong evidence supporting the intrinsic healing mechanism by tenocytes and tenoblasts. Other studies show that the healing of immobilized tendon repair begins with the extrinsic mechanism followed by the intrinsic mechanism.
There is ongoing controversy about whether the repaired tendon should be immobilized completely, partially, or not at all. A number of studies have shown that actively mobilized tendon repair can heal with less or no restraining adhesion followed by satisfactory functional recovery. However, a common drawback of currently popular techniques of tendon repair of which I am aware is that they do not provide enough tensile strength with safety margins for early active mobilization. When a tendon is repaired with any of these techniques, immediate active mobilization will likely separate the tendon juncture as a result of elongation of the suture frame, breakdown of the sutures or pull through of the sutures.
Accordingly, there exists an unfulfilled need in modern hand surgery for a tendon repair technique with sufficient tensile strength and safety margin to enable early active mobilization likely to discourage stiff joints, adhesion and flexion contracture while enhancing the intrinsic healing mechanism aided by synovial diffusion.